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HomeMy WebLinkAboutResolution - 2017-R0234 - Water Treatment Chemicals Dba Summit Chemical Specialty Products - 07_13_2017Resolution No. 2017-RO234 Item No. 6.5 July 13, 2017 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, a Contract related to Coagulant for South Water Treatment Plant, by and between the City of Lubbock and Water Treatment Chemicals dba Summit Chemical Specialty Products, and related documents. Said Contract is attached hereto and incorporated in this Resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on July 13 52017 ATTEST: f)'jq4"-' '�o Re ecca Garza, City Secret ty DANIEL M. POPE, MAYOR -, APPROVED AS TO CON ENT: Mark Yearwood, Assistant City Manager APPROVED AS TO FORM: I ovu vl� V-X-� C,-( RES.Contract-Nbr 13373-Coagulant for South Water Treatment Plant (6-20-17) Resolution No. 2017-RO234 Contract 13373 City of Lubbock, TX Contract for Coagulant for South Water Treatment Plant THIS CONTRACT made and entered into this 13th day of July, 2017, by and between the City of Lubbock ("City"), and Water Treatment Chemicals dba Summit Chemical Specialty Products, ("Contractor"). WITNESSETH: WHEREAS, the City of Lubbock duly advertised for bids for Coagulant for South Water Treatment Plant and bids were received and duly opened as required by law; and WHEREAS, after careful consideration of the bid submitted by Contractor, the City authorized the execution, in the name of the City of Lubbock a contract with said Contractor covering the purchase and delivery of the said Coagulant for South Water Treatment Plant. NOW, THEREFORE, in consideration of the mutual agreement contained herein, as well as the financial consideration hereinafter referred to, the parties hereby covenant and agree as follows: In accordance with City's specifications and Contractor's bid, copies of which are attached hereto and made part hereof, Contractor will deliver to the City, Coagulant for South Water Treatment Plant and more specifically referred to as Item 2 on the bid submitted by the Contractor or in the specifications attached hereto. 2. The City promises and agrees to employ, and does employ, the Contractor to cause to be done the work provided for in this Contract and to complete and finish the same according to the attached specifications, offer, and terms and conditions contained herein. The Contractor shall perform the work according to the procedures outlined in the Bid Form and Specifications attached hereto. The contract shall be for a term of one year, with the option of two, one year extensions, said date of term beginning upon formal approval. The rates may be adjusted upward or downward each year at a percentage not to exceed the effective change in the Consumer Price Index (CPI) or Product Price Index (PPI), whichever is most appropriate for the specific contract for the previous year. Written consent fi-om both parties is required for all price adjustments. At the City's discretion, the effective change rate shall be based on either the local or national index average rate for all items. If agreement cannot be reached, the contract is terminated at the end of the current contract period. All stated annual quantities are approximations of usage during the time period to be covered by pricing established by this bid. Actual usage may be more or less. Order quantities will be determined by actual need. 4. This contract shall remain in effect until the first of the following occurs: (1) the expiration date, (2) performance of services ordered, or (3) termination of by either party with a 30 day written notice. Such written notice must state the reason for cancellation. The City of Lubbock reserves the right to award the canceled contract to the next lowest and best bidder as it deems to be in the best interest of the city. 5. Contractor shall at all times be an independent contractor and not an agent or representative of City with regard to performance of the Services. Contractor shall not represent that it is, or hold itself out as, an agent or representative of City. In no event shall Contractor be authorized to enter into any agreement or undertaking for or on behalf of City. INSURANCE, SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed Insurance Certificate to the City, which shall be completed by an agent authorized to bind the named underwriter(s) to the coverages, limits, and termination provisions shown thereon, and Which shall furnish and contain all required Information referenced or Indicated thereon. THE CITY Y SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE SHALL HAVE BEEN DELIVERED TO THE CITY. SECTION B. The City reserves the right to review the insurance requirements of this section during the effective period of the contract and to require adjustment of insurance coverages and their limits when deemed necessary and prudent by the City based upon changes in statutory law, court decisions, or the claims history of the industry as well as the Contractor. SECTION C. The Contractor shall obtain and maintain in full force and effect for the duration of this contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies approved by the State of Texas and acceptable to the City, in the following type(s) and amount(s): TYPE OF INSURANCE GENERAL LIABILITY ® Commercial General Liability ❑ Other ❑ Claims Made ® Occurrence ❑ W/Heavy Equipment ❑ To Include Products of Complete Operation Endorsements PROFESSIONAL LIABILITY AUTOMOTIVE LIABILITY ® Any Auto ❑ Scheduled Autos ❑ Non -Owned Autos EXCESS LIABILITY ❑ Umbrella Form GARAGE LIABILITY ❑ Any Auto El ❑ BUILDER'S RISK ❑ INSTALLATION FLOATER ® POLLUTION ❑ CARGO ❑ All Owned Autos ❑ Hired Autos COMBINED SINGLE LIMIT General Aggregate 1.000 000 Products-Comp/Op AGG X Personal & Adv. Injury X Contractual Liability X Fire Damage (Any one Fire) Med Exp (Any one Person) General Aggregate Combined Single Limit Each Occurrence $1.000.000 Each Occurrence Aggregate Auto Only - Each Accident Each Accident Aggregate ❑ 100% of the 'Total Contract Price ❑ 100% of the Total Material Costs 1 000 000 ® WORKERS COMPENSATION —STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY ® EMPLOYERS' LIABILITY $1,000.000 OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED ® City of Lubbock named cis additional insured on A:ito General Liability on a primary crud non-contributory basis. ® To include products ofcompleted operations endorsement. ® Waiver ofsubrogation in favor oj'the City of Lubbock on all coverages, except The City of Lubbock shall be named as an additional insured on a primary and non-contributory basis and shall include waivers of subrogation in favor of the City on all coverage's. Copies of the Certificates of Insurance and all applicable endorsements are required. ADDITIONAL POLICY ENDORSEMENTS The City shall be entitled, upon request, and without expense, to receive copies of the policies and all endorsements thereto and may make any reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions (except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any of such policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish such changes in policy coverages, and shall pay the cost thereof. REQUIRED PROVISIONS The Contractor agrees that with respect to the above required insurance, all insurance contracts and certificate(s) of insurance will contain and state, in writing, on the certificate or its attachment, the following required provisions: a. Name the City of Lubbock and its officers, employees, and elected representatives as additional insureds, (as the interest of each insured may appear) as to all applicable coverage; b. Provide for thirty (30) days' notice to the City for cancellation, nonrenewal, or material change: c. Provide for notice to the City at the address shown below by registered mail; d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees, and elected representatives for injuries, including death, property damage, or any other loss to the extent same may be covered by the proceeds of insurance; e. Provide that all provisions of this contract concerning liability, duty, and standard of care together with the indemnification provision, shall be underwritten by contractual liability coverage sufficient to include such obligations within applicable policies. NOTICES The Contractor shall notify the City in the event of any change in coverage and shall give such notices not less than 30 days prior the change, which notice must be accompanied by a replacement CERTIFICATE OF INSURANCE. All notices shall be given to the City at the following address: Marta Alvarez, Director of Purchasing and Contract Management City of Lubbock 1625 13" Street, Room 204 Lubbock, Texas 79401 SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by the Contractor shall not relieve the Contractor of full responsibility or liability for damages and accidents as set forth in the contract documents. Neither shall the bankruptcy, insolvency, or denial of liability by the insurance company exonerate the Contractor from liability. 7. Neither the City nor the Contractor shall assign, transfer or encumber any rights, duties or interests accruing from this Contract without the written consent of the other. The City reserves the right to exercise any right or remedy available to it by law, contract, equity, or otherwise, including without limitation, the right to seek any and all forms of relief in a court of competent jurisdiction. Further, the City shall not be subject to any arbitration process prior to exercising its unrestricted right to seek judicial remedy. The remedies set forth herein are cumulative and not exclusive, and may be exercised concurrently. To the extent of any conflict between this provision and another provision in, or related to, this document, this provision shall control. 9. At any time during the term of the contract, or thereafter, the City, or a duly authorized audit representative of the City or the State of Texas, at its expense and at reasonable times, reserves the right to audit Contractor's records and booKM relevant to all services provided to the City under this Contract. hl the event such an audit by the City reveals any errors or overpayments by the City, Contractor shall refund the City the full amount of such overpayments within 30 days of such audit findings, or the City, at its option, reserves the right to deduct such amounts owing the City from any payments due Contractor. City of Lubbock Bid ITB 17-13373-KM 10. All funds for payment by the City under this contract are subject to the availability of an annual appropriation for this purpose by the City. In the event of non -appropriation of funds by the City Council of the City of Lubbock for the goods or services provided under the contract, the City will terminate the contract, without termination charge or other liability, on the last day of the then -current fiscal year or when the appropriation made for the then -current year for the goods or services covered by this contract is spent, whichever event occurs first. If at any time funds are not appropriated for the continuance of this contract, cancellation shall be accepted by the Seller on thirty (30) days prior written notice, but failure to give such notice shall be of no effect and the City shall not be obligated under this contract beyond the date of termination. 11. The Contractor shall not assign or sublet the contract, or any portion of the contract, without written consent from the Director of Purchasing and Contract Management. Should consent be given, the Contractor shall insure the Subcontractor or shall provide proof on insurance from the Subcontractor that complies with all contract Insurance requirements. 12. This Contract consists of the following documents set forth herein; Invitation to Bid No. 17-13373-KM, Specifications, and the Bid Form. IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and year first above written. Executed in triplicate. CITY OF LUB CK Daniel M. Pope, Mayor ATTEST: D-9— 'J � Reb cca Garza, City Secret ry APPR VED AST ONTENT: Aub y A. p r, P.E., Director of Water Utilities APPROVED AS TO FORM: Amy s, ty City ey CONTRACTOR By - Authorized Representative Print Name +-"' � 1 v ';�J2 P �' _ST'�_� 7� p Address AJ City, State, Zip Code 4/13/2017 9:07 AM p. 40 BID FORIM Coagulant for South Water "Treatment Plant City of Lubbock, TX ITB 17-13373-KINI In compliance with the Irritation to Bid 17-13373-KAI, the undersigned Bidder hacine examined the Invitation to Bid and Specifications, and being familiar with the conditions to he met, hereby submits the folloNkint> Bid for fumishin- the material, equipment, labor and e,,erything necessary for providing the items listed helo« and agrees to deli\cr said items at the locations and for the prices set forth on this form. A hid will he subject to heing considered irregular and may be rejected i1 it shoe, omissions, alterations of form, conditional alternate bids, additions or alternates in lieu of the items specified. if the unit prices are obviously unbalanced (either in excess of or below reasonably expected values), or irregularities of any kind. I he Imitation to Bid 17-13373-K:NI is by reference incorporated in (his contract. The Bid Forst must be completed in blue or black ink or by typewriter. Vty UNIT OF ITEM DESCRIPTION (* ) MEASURE l iNIT PRICE• E\TE �'UE) C'OS1 1 • f' k( 1 Coagulant for South Water Treatment Plant 150 R)\ — S 2. ;, 11 Coagulant for South 1k ater Treatment Plant 1 �0 TO\ I{ `T 1 V r .1 Total (Items 1 - 2) S *PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed DC:r_t v (C 1 - {'s (VjZ Unless otherwise specified herein, the City may award the bid either item -by -item or on an all -or -none basis for any item or group of items shown on the bid. The City of Lubbock is seeking a contract for Coagulant for South Water Treatment Plant with one or store contractors. In order to assure adequate coverage, the City may make multiple awards, selecting multiple vendors to provide the products desired, if multiple awards are in the best interest of the City. A decision to make it multiple award of this Bid, however, is an option reserved by the City, based on the needs of the City. PAYMI:Nl FERb1S AND INSCOUN"I'S - Bidder ollers a prompt payment discount of 04 net — calendar Jas s I)ise wnls ll not he considered in determining tow bid. Unless otherwise indicated on the Bid Form, payment terms will he NIA 1111Rl Y DAYS. the City 'sill pay the successful bidder within thirts dass alter the receipt ol'a correct invoice or after the date of acceptance• %Oichcccr dent occurs later. Discounts for prompt payment requiring payment by the City within a stipulated number of days «ill he interpreted as applying «ithin the stipulated number of calendar Jaws after the date of receipt bs the ('in of a correct invoice or after the date of accepemcc th,u meets contract requirements. %\hichc\ cr cscn( occurs later. DiCtlmlts for pasmcnt in Icss than ten das' x%ill not he arn'iderCJ. MoS I FAVoI'REI) PRICIN(; the Bidder ccrtilies that the price quoted is not in e\ccss of the loucst price charged anonc else, including its most lacoured customer. firr like quality attd quantih oI the products,'scrcices: does not include an element of pnHit on the <alc in Ctccs> of that norntalk obtained bs the Bidder on the sale of product;, sen ices of like quality and quantity; and does not include am prop i;tun li,r discounts to selling agents. Ifat any time during the contract pCriod, the supplier ,houlJ sell or ollcr lur sale to tmx other customer. an equal or less quantity of similar contract products of like or letter quality, at a lower net price(s) than provided herein, supplier agree; to motif"_ the City and sell same product(s) at the lower price(s) on all dcliscrics made during the period in which such lower price(') is etl�ctnc. IN FERLOC AI. PURCHASING (optional): The Cit_s desires to make a%ailahle to other local go�ernmcntal entities of the State of ICsas_ h mutual agreement %%ith the successful bidder, and properly authorised interlocal purchasing agreements as prusidcd bur hs the Intcrlocal Cooperation Act Whaptcr 791. Gosemment Code), the right to purchase the same scrNices, at the prices quoted, firr the period ol'this contract. Bach bidder shall indicate on the Bid Form in the space pruwided bclo�\ if' hc:shc will honor Political Suhdicision orders in addition to orders from the City of Lubbock. Should these other gosemmental entities decide to participate in this contract, s%ould you (thc bidder) agree that all terms, conditions. specifications, and pricing ssould apply'? Other governmental entities that might have interests in this contract are Frenship Independent School District, Lubbock (lousing Authority, Lubbock County, Lubbock County (Hospital District, Lubbock Independent School District, South Plains .Association of Governments, City of Texarkana, Texas "Tech University, \\ est Texas .Municipal Power .Agency, Lynn County, and City of Wolfforth. YES ✓ NO 0 If you (the bidder) checked YES, the following will apply: • Governmental entities utilizin, Interlocal A,rectnent.� li)r Cooperatke Purchasing N%iih the C'il% ut 1-uhhock %gill he elicible• but not obligated, to purchase ntaterials.ser%ice,, under the contract(s) d�%ardcd as a result of"this solicitation. 1\11 purchases by governmental entities other than the C'itN of Lubbock %-,ill he billed directIN to that go%ertmental entity and paid by that governmental entire. Cit% of Lubbock will not be responsible lur another governmental entity 's debts. Each gosemmental entitN will order their o%tin material s'service as needed. _ THIS HID IS SI'Mil I I'ED BYr Arfti_ ��� A1;a tip r a corporation organized under the la\\s of the State of f �J '• L �'�. or a partnership consistimg of _ or indis idual tra&w-, .i< of the Citv of - Firm: u'�1 li rL �,•t. J\ i,'`'C-.; (. 1{t::%{� �;�. `�J! !/ `�r {�' �,t !i`<\t ` �� '�� �+r •�i�. "� Address: r Cit}: r k, IV I ti' State: `' Zip Bidder ackno«led ges receipt of the foIIt wing addenda: Addenda No. t Date 4 Addenda No. Date Addenda No. Date Addenda No. Date BE Firm: woman Black American Native American Hispanic American I I Asian Pacific Americl I Other (Specify) B,.^� J 11'4 A^ (� -'�.. Date: I uthori:4?d Relpresewative - must .ciifn ht• hun t' (fluor \•ame and 1 itle' Please feint i � i Business Telephone Number =� t L i = 7✓ t � 'I FAX: I t t ; i_ � , t E-mail Address: kKIW , f� i, 'V, . 11/1, ..i (.: h . 141 , i tnt FOR CITY I SE ONLY Bid Form Item \urnber(s) A�%arded to Abovc Named Firnuindkidual: Date of.lward by C'it% Council (IM-hide over 1 0.000): Date P.O.'C'ontract Issued: RETURN COMPLETED & SIGNED BID FORM ALONG WITH CITY OF LUBBOCK SPECIFICATIONS. LABEL THE OUTSIDE OF YOUR SEALED BID'<'<IT11 TIIE ITB NUMBER, THE CLOSING DATE. ANDTIME, AND YOUR COMPANY NAME AND ADDRESS. City oft.ubbocic,'rX Coagulant for South Water Treatment Plant ITti 17-13373-KNI Specifications SCOPE It is the intent of these specifications to describe products to be used a, a coagulant at the Cite of L.ubhock South Water Treatment Plant. 2. PRODUCT SPECIFICNFION The City of Lubbock owns and operates a membrane filtration plant, only Polyaluminunt Chloride (PACT.) or Aluminum Chloroh),drate(ACII) v%ill be considered. No product containing polymer will be considered due to membrane fouling. The coagulant purchased for use at the Cite of Lubhock South Water Treatment Plant shall strictly adhere to American Water Works Association (AWWA) Standard B408-14 for Liquid Pole -aluminum Chloride and ACH Aluminum C}tlorohydrate or latest revisions thereof. The coagulant blend 111u,t hake NSF International/.American National Standards Institute (.ANSI) Certification fir use in potable eater treatment plants. Bidder shall submit a certificate of analysis which will include the specific gravity and pH. The material safety data sheets (:MSDS) for the product shall also be submitted with the hid. Ifthe successful bidder is not the manufacturer of the coagulant bid, bidder must provide a cop} of'a legal contract between the bidder and the coagulant manufacturer that will be used to produce the blend. In an, event, all products u,cd must have NSF/ANSI certification for use in drinking water treatment plants. The same coa-ulant manutiicturer must be used throughout the term of the contract. Throughout the term of the contract, the successful bidder may not change the formulation of the coagulant in any way without the express written consent of the Water Operations Manager. No exceptions, an unauthorized change in the formulation of the product will result in contract termination. 3. PRODCT PERFORMANCE If product being bid has not been previously tested fir performance at the City of Lubbock South Water I real Plant bidder may be required by the City to visit the site and perform testing using standard jar testis-, method;. The test results must include settled water and final water turbidities, pH and temperature. A .,ample ol'the product being tested will be left at the facility fir additional jar testing by Operations personnel. At the Citie,' discretion full plant testing will be required based on results of previous tests; the City %kill pay for a full delivery (approximately 48,000 lbs.) at the price submitted in the bid document to conduct full plant testis,,. Water Treatment Operations personnel will evaluate product performance based on settled water quality, pII. filter effluent turbidities. and cost effectiveness. Bidders must submit a list %%ith a minimum of three (? ) potable water treatment plants %%ith phone nunthers and contact persons that are currently u;inL' the product. References %kill be thorou�_hly checked and %%ill figure prominently into the selection of a successful bidder. 4. PRODUCT QUALITY PER LOAD Upon delivers of' each load of product, the transport driver must present a certificate of' analysis containing specific gravity and pH. Plant operations staff will also perform specific gravity and pH analyses on the product in the presence of the transport driver. A delivered product that exhihits any unusual color or appearance compared to previous acceptable deliveries will be refused, as will deliveries containing and Timm of foreign material. If the product meets the required minimum standards, the product ntay then he oil' loaded into the stora-e tanks. If desired, the vendor may provide their own hydrometer and perform an additional specific gravity analysis in the presence of the plant operations staff. In the event the product doe, not meet the required minimum standards, the load will be refused and the vendor must provide another acceptable load within forty eight (48) hours. No additional freight or shipping charges shall be assessed by vendor. TECHNICAL SUPPORT Vendor shall provide acceptable technical support and response time whenever problems are encountered relating to product use and/or perl'ormance. Acceptable technical support will include routine,ite �i>its at teat even three (3) months to ped'orm jar testing and consulting with operation, staff on any questions or problem, w ith the product. A telephone response time of one ( I ) business day is required of vendor in cases of product perfonnance problems. A site visit by the vendor may be requested by the owner if owner feels it is necessan to solve any siLnificant problem related to product performance. If a non -routine site visit is requested. the vendor will have ti%e (5) business days to respond and arrive on -site. If at -,in% tinle during.; the duration of the contract a significant change in the source water is experienced vendor will have five (�) business da,-s to respond and anise on -site to test and evaluate current process and recommend changes in the product if needed. All technical support �%ill be at no cost to the CitN of Lubbock. 6. BIDACCEP ANCE Product pertornlance %ill be required to meet optimum quality results for settled and effluent eater. The evaluation of bids will include a set of eater quality parameters that nlu;t be nlet through the above outlined testing procedures. The bid will be awarded based on «ater quality and overall visual plant pertornlance, cost effectiveness. and reference checks. QUANTITIES AND PRICING The anticipated annual consumption coagulant use is 150 tons more or less. Prices quoted for product shall be FOB City of Lubbock South Water Plant, i 1 1 4 East FM 1585, Lubbock. Texas. The contract shall he for a terns of one year, with the option of two, one year extensions. said date of term beginning upon formal approval. The rates may be adjusted upward or downward each }ear at a percentage not to exceed the eftectke change in the Consumer Price Index (CPl) or Product Price Index (PPI), whlche\cr is most appropriate for the specific contract for the previous year. Written consent from both parties is required for all price adjustments. At the City's discretion, the etlfective change rate shall be based on either the local or national Index average rate for all items. If agreement cannot be reached, the contract is terminated at the end of the current contract period. All stated annual quantities are approximations of usage during the tinge period to be covered by pricing established by this bid. Actual usage nla,� be more or less. Order quantities will be determined by actual need. 8. DELIVERY / SECURITY Successful vendor shall be required to deliver the product to the City of Lubbock South Water Treatment Plant in bulk tank truek within five (5) days after order is placed. Unloading to plant storage tanks is to be performed by the drier under the direction of operations personnel. Successful vendor shall provide an` arid all special equipment necessary to perform unloading at no cost to the City of Lubbock. All deliveries will be unloaded between the hours of 8:00 A.M. and 4:00 P.M., Monday through Friday. No exceptions will be made unless prior approval is agreed upon with the Water Treatment Plant's operations personnel. The transporter is required to furnish certified, dated, and stamped weight tickets with each load of product. before and after unloading. .All delivery people will display photo security ID upon arrival at the site. All delivery vehicles shall nll'et OSHA and DOT regulations and be operated in a sate manner while on site. Call the representative. Matt Kerley at the South Water Treatment plant to schedule delivery, 806-775-262 4. All shipments shall be sealed and the seal will be broken only in the presence ofthe plant representative. CERTIFICATE OF INTERESTED PARTIES FORM 1295 1 of 1 Complete Nos. 1- 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2017-226930 Date Filed: 06/21/2017 Date Acknowledged: 06/22/2017 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Summit Chemical Specialty Products Flemington, NJ United States 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. City of Lubbock 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. ITB 17-13373-KM Water Treatment Chemicals 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. ❑ X 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said this the day of 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883 CERTIFICATE OF INTERESTED PARTIES FORM 3.295 1of1 Complete Nos. 1- 4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos, 1, 2, 3, 5, and 6 if there are no interested parties. CERTIFICATION OF FILING Certificate Number: 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2017-226930 Summit Chemical Specialty Products Flemington, NJ United States Date Filed: 06/21/2017 2 Name of governmental entity or state agency that is a party tot the contract for which the form is being filed. City of Lubbock Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. ITB 17-13373-KM Water Treatment Chemicals 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling I Intermediary 5 Check only if there is NO Interested Party. X 5 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. ADRIANNA L ZUFALL CUMN county Mwimm My Ct;trrlRtit Won �Uro 10� 2019 Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE 2c Sworn and subscribed before me, by the said � U S ,this the � � day of t�A yl,L_., 20 to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer adrhinistering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us version v1.0.883